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Report details flaws in Army's handling of PTSD

File-This computer-screen photo taken Friday, June 29, 2007 of an experimental virtual-reality computer simulation at Madigan Army Medical Center at Fort Lewis, Wash. Planned on being used by psychologists to treat soldiers suffering from post-traumatic stress disorder. The Army has more than doubled its number of military and civilian behavioral health workers in the past five years, but a litany of shortcomings still plagues the force when it comes to diagnosing and treating soldiers for post-traumatic stress disorder, according to an Army report being released Friday March 8,2013. (AP Photo/Ted S. Warren,File)

SEATTLE (AP) — An Army report released Friday finds the service still has trouble diagnosing and treating soldiers for post-traumatic stress disorder, despite more than doubling its number of military and civilian behavioral health workers over the past five years.

Confusing paperwork, inconsistent training and guidelines, and incompatible data systems have hindered the service as it tries to deal with behavioral health issues, the report said. It's a crucial issue: After a decade of war, soldier suicides outpace combat deaths.

Last May, the Army commissioned a task force to conduct a sweeping review of how it evaluates soldiers for mental health problems at all its facilities. The review came under pressure from Democratic Sen. Patty Murray, of Washington, who was upset to learn that hundreds of soldiers at Madigan Army Medical Center south of Seattle had had their PTSD diagnoses reversed by a forensic psychiatry team, resulting in a potential cut to their benefits and questions about whether the changes were made to save money.

About 150 of those soldiers eventually had their diagnoses restored.

"I am pleased that the Army completed this review and has vowed to make fixes over the next year, though I am disappointed it has taken more than a decade of war to get to this point," Murray said in a statement. "Many of the 24 findings and 47 recommendations in this report are not new. Creating a universal electronic health record, providing better rural health access, and standardizing the way diagnoses are made, for instance, have been lingering problems for far too long. Our service members and their families deserve better."

The report noted that the Army had made strides in some areas, including cutting how long it takes soldiers to obtain a disability evaluation and publishing a guide to the process.

On a conference call with reporters, Army brass emphasized that many of the report's recommendations are already being put into effect. For example, over the past year the Army has been assigning behavioral health workers to brigade combat teams so soldiers will feel more familiar with them and more comfortable about getting help, said Lt. Gen. Patricia D. Horoho, who heads the Army's Medical Command.

Horoho also stressed that there was no evidence that malice motivated the altered diagnoses at Madigan; rather, the changes amounted to difference of opinion, she said.

The task force interviewed 750 people stationed around the globe, conducted listening sessions with 6,400 others and reviewed more than 140,000 records. The Medical Command reviewed diagnoses for all soldiers evaluated for behavioral health problems from October 2001 until last April.

Since September 2001, the report found, 4.1 percent of all soldiers deployed wound up in the disability system with a behavioral health diagnosis such as PTSD or traumatic brain injury.

Nationwide, the report said, 6,400 soldiers had behavioral health diagnoses "adjusted" by medical evaluation boards, with approximately equal numbers having PTSD added as a diagnosis and removed as a diagnosis.

Two locations where medical evaluation boards are held had slightly higher rates of diagnosis changes than the Army-wide average — Fort Polk in Louisiana and Fort Irwin in California, Horoho said. Cases from those locations are being reviewed to ensure no soldiers were improperly affected, but part of the reason for the higher rates may be because those bases rely heavily on civilian health workers, she said.

Last year the Army — and the military as a whole — suffered the highest number of suicides ever recorded, prompting then-Defense Secretary Leon Panetta to declare it an epidemic. The Army had 183 suicides among active-duty soldiers, up from 167 in 2011, and the military as a whole had 350 suicides, up from 301 the year before.

Among the problems the report documented was that Army bases don't have a person on site dedicated to overseeing behavioral health issues, despite the many problems they can cause: suicide, alcohol abuse, drug abuse, and child and spouse abuse. Each installation needs someone with a view of all those programs to make recommendations to the commander, the report said.

Army Secretary John M. McHugh said in a statement that the Army will work to place behavioral health experts "at the command and installation levels to provide better consultation, guidance, coordination and recommendations to improve behavioral health care for our soldiers."

The task force found that of the soldiers surveyed, 37 percent had never received any information about the Army's disability evaluation system or had to seek the information out on their own. It also said it was confusing and inefficient for troops to navigate the vastly different disability systems maintained by the Army and the Veterans Administration.

The Army and VA plan to have a joint disability system, by which health care providers in either organization will have access to records, by 2017.

"Some changes can be made immediately," McHugh said. "Others will require more time and coordination. Importantly, this report reviewed our systems holistically — recommending not only short-term solutions, but longer term, systemic changes that will make care and treatment of our soldiers and family members more effective."